Use Of Angioembolization In Blunt Splenic Trauma: A Propensity Score Analysis Of The National Trauma Data Bank
Robert A Swendiman1, Myron Allukian, III2, *Stephen J Fenton3, Matthew A Goldshore1, *Michael L Nance2
1Hospital of the University of Pennsylvania, Philadelphia, PA;2Children's Hospital of Philadelphia, Philadelphia, PA;3University of Utah, Salt Lake City, UT
Background (issue): The use of angioembolization (AE) in the management of blunt solid organ injuries in pediatric trauma remains unclear. We sought to further define its role in splenic salvage.
Methods: The National Trauma Data Bank (2010 - 2014) was queried for pediatric patients (<18 years) who experienced blunt splenic trauma. Patient demographics, injury characteristics, and clinical outcomes were collected. Children undergoing AE were compared to those who did not undergo AE using a 1:1 propensity score matched analysis to compare rates of splenic salvage between AE and non-AE patients with analogous injury patterns.
Findings: Of 14,539 children with blunt splenic trauma, 555 (3.8%) underwent AE. Use of AE increased yearly from 2.8% to 5.0% (p<0.001). Bivariable analyses demonstrated that patients undergoing AE were more likely to be older (median 16 vs. 13 years, p<0.001), present in shock (41.5% vs. 28.2%, p<0.001), have higher abdominal Abbreviated Injury Scale scores (p<0.001), require a laparotomy (p=0.05), and be treated at adult versus pediatric trauma centers (p<0.001) compared to non-AE patients. After propensity score matching, there was no difference in rates of splenectomy: 10.0% for non-AE versus 7.9% in AE patients (p=NS). Median length of stay, however, was longer for patients undergoing AE (6 vs. 5 days, p<0.001).
Conclusions (implications for practice): We found no association between AE and rates of splenic salvage for children with blunt splenic injuries. These results highlight the need for large, multicenter prospective trials to investigate the increasing role of this intervention in children.
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